Definition
Change of Ownership (CHOW)
A change of ownership (CHOW) is a Medicare-defined transfer of a certified facility, such as a hospital or nursing home, to a new owner, which triggers rules on whether the existing Medicare provider agreement passes to the buyer.
1 min readReviewed September 14, 2026
Also known as: Medicare change of ownership, Facility ownership change
Key facts
- Regulation
- 42 CFR 489.18
- Default outcome
- The provider agreement is automatically assigned to the new owner
- Alternative
- The new owner can reject assignment and enroll as a new provider
- Reported on
- Form CMS-855A or PECOS
- Public data
- CMS publishes hospital and SNF change of ownership files
What is a change of ownership?
Medicare certifies facilities, not just companies, and signs a provider agreement with each one. When a hospital, skilled nursing facility, home health agency or other certified provider is sold, Medicare has to decide what happens to that agreement. Federal rules define which transactions count as a change of ownership.
Examples include a sale of the facility assets, the merger of the provider corporation into another corporation, a change in partners of a partnership, and leasing the whole facility. A simple transfer of corporate stock generally does not count as a CHOW, although it must still be reported as an ownership change.
How a CHOW works
By default, the existing provider agreement is assigned to the new owner, with all of its terms and conditions. The facility usually keeps its CMS Certification Number (CCN), and the new owner takes on liability for past Medicare overpayments.
The buyer can instead reject assignment. Then the old agreement terminates, and the facility must enroll and be certified as a new provider, with a gap in Medicare payment until approval. Either way, the change must be reported to CMS through Form CMS-855A or PECOS.
Why CHOW data matters
Ownership changes are a leading signal in health care markets. Private equity and chain acquisitions of nursing homes, home health agencies and hospitals show up first as CHOW filings. CMS now publishes change of ownership files for hospitals and skilled nursing facilities that list buyer, seller and effective date.
For sales and market access teams, a recent CHOW often means new decision makers, new contracts and new purchasing policies. For analysts, keeping the CCN constant through a CHOW is useful for trend lines, but it can hide that a facility now belongs to a different system.